相信许多人都会有疑问，电子内窥镜贵，为什么还要做成一次性的？为什么能够做成一次性的？让我们一起来扒一扒它的出生，看一看它的经历。

　　Many people may wonder why electronic endoscopes, which are the most expensive, are still made disposable? Why can it be made disposable? Let's take a look at its birth and its experiences together.

　　在内窥镜200多年的发展历程中，出现了几次重大技术突破，将内窥镜带入了不同的发展阶段：整体经历了早期硬管式内窥镜、半可屈式内窥镜、纤维内窥镜、CCD电子镜以及CMOS电子镜四个阶段。还有些人会把胶囊内窥镜列入第五阶段，这是我们现阶段正在经历的转变，能不能列为第五阶段还有待商榷。所以，在此我就把胶囊内窥镜列入创新发展里。同样，许多其他新技术也列入该类进行讨论。

　　In the more than 200 years of development of endoscopes, there have been several major technological breakthroughs that have brought endoscopes into different stages of development: they have gone through four stages: early rigid tube endoscopes, semi flexible endoscopes, fiber endoscopes, CCD electronic microscopes, and CMOS electronic microscopes. Some people still classify capsule endoscopes as the fifth stage, which is a transformation we are currently experiencing. Whether it can be classified as the fifth stage remains to be discussed. So, I will include capsule endoscopy in the innovative development here. Similarly, many other new technologies are also included in this category for discussion.

　　01内窥镜的发展历程

　　The Development History of 01 Endoscope

　　阶段：光学硬镜、半屈式内镜（1806年起） 1806年，德国医生Philip Bozzini在病人的肛门内插入一根硬管，借助于蜡烛的光亮，观察膀胱和直肠内部病变，他将其称为"LICHTLEITER"，这被认为是内窥镜发展史的开端。但当时的人们并不理解这种检查方法， Bozzini 也因他的“好奇心”受到维也纳 医学院的处罚。次将"LICHTLEITER”运用于人体的是法国外科医生 Desormeaux因此他被许多人誉为“内窥镜之父”。他的“LICHTLEITER”是以烧煤油和松节油的灯为光源，灯的上方带有烟囱并用透镜将光线聚集以增加亮度，可想而知灼伤是进行这种检查时的主要并发症。虽然这种内窥镜可以到达胃，但光线太暗，所以“LICHTLEITER”主要用于检查泌尿系方面的疾病。1868 年，Desormeaux 和 Segelar 次在一篇文章中使用“内窥镜”一词。Philip Bozzini的“LICHTLEITER”

　　In 1806, German doctor Philip Bozzini inserted a hard tube into the patient's anus and used the light of a candle to observe the internal lesions of the bladder and rectum. He called it the "LICHTLEITER", which is considered the beginning of the history of endoscopic development. But at that time, people did not understand this examination method, and Bozzini was also punished by the Vienna Medical School for his "curiosity". The first time the "LICHTLEITER" was applied to the human body was by French surgeon Desormeaux, who is widely known as the "father of endoscopes". His "LICHTLEITER" uses a kerosene and turpentine burning lamp as a light source, with a chimney above the lamp and a lens to concentrate the light to increase brightness. It can be imagined that burns are the main complication of this examination. Although this endoscope can reach the stomach, the light is too dim, so "LICHTLEITER" is mainly used to examine urinary system diseases. In 1868, Desormeaux and Segelar first used the term "endoscope" in an article. Philip Bozzini's' LICHTLEITER '

　　1932年，德国人Schindler与Wolf成功研制出一种半屈式内镜，定名为 Wolf-Schindler式胃镜。这种内镜由48个透镜组成光学系统，灯泡光亮度强，医生能清晰地观察图像。真正意义上的个半可屈式胃窥镜是由 Schindler从 1928 年起与的器械制作师 Wolf 合作开始研制的 并终在1932年获得成功 该胃镜直径为12mm长为 77cm，光学系统由 48 个透镜组成，前端部分可在不同水平面弯曲34°，即在胃内有一定范围的弯曲，使术者能清晰地观察胃粘膜图像，该胃镜前端有一光滑金属球，插入较方便，灯泡光亮度较强，有空气通道用以注气，近端为硬管部，有接目镜调焦。

　　In 1932, German Schindler and Wolf successfully developed a half flexion endoscope, which was named Wolf Schindler gastroscope. This endoscope consists of an optical system consisting of 48 lenses, and the light bulb has strong brightness, allowing doctors to observe images clearly. The first semi flexible gastroscope in the true sense was developed by Schindler in collaboration with the excellent instrument maker Wolf since 1928, and finally succeeded in 1932. The diameter of the gastroscope is 12mm and the length is 77cm. The optical system consists of 48 lenses, and the front end can bend 34 ° at different horizontal planes, which means there is a certain range of curvature in the stomach, allowing the surgeon to clearly observe the image of the gastric mucosa. The front end of the gastroscope has a smooth metal ball, which is easy to insert, and the light bulb has strong brightness. There is an air channel for gas injection, and the proximal end is a hard tube part with a focusing eyepiece.Wolf-Schindler 式胃镜的创制，开辟了胃镜检查术的新纪元。

　　Schindler与Wolf的Wolf-Schindler式胃镜

　　Schindler and Wolf's Wolf Schindler style gastroscopy

　　1960年，卡尔史托斯公司成功研发冷光源；1965年，卡尔史托斯公司研发推广HOPKINS柱状透镜技术，直今天，硬性光学镜仍使用这一结构。

　　In 1960, Karl Storz successfully developed a cold light source; In 1965, Karl Storz developed and promoted the HOPKINS cylindrical lens technology, which is still used in rigid optical mirrors today.

　　第二阶段：光纤内镜（1957年起） 1954年，基于之前纤维传导光源及纤维间加盖覆层可以纤维间光绝缘的理论基础，英国Hopkings及Kapany研究了纤维的精密排列，有效地了纤维束的图像传递，为纤维光学的实用奠定了基础。内窥镜实现了一大历史性突破，应用光纤传像的内镜登上舞台。 1957年，Curtiss和Hirschowitz把大量的玻璃纤维薪合成一束，并在末端把这些纤维融合在一起，以便使它们根据自身的长度独立活动，就此造就了个软质内镜。Hirschowitz和他的研究组制成了世界上个用于检查胃、十二指肠的光导纤维内镜原型。 1960年，美国膀胱镜制造者公司（ACMI，现在年轻人应该都不知道这个了，都成传说了）向Hirschowitz提供了个商业纤维内窥镜。1964年，Olympus 厂在光导纤维胃镜基础上，加装了活装置及照相机，有效地显示了胃照相术，实时观察胃内状况。1966 年 Olympus 厂首创前端弯角机构。1967年，Machida厂采用外部冷光源，使光亮度大增，可发现小病灶，视野进一步扩大，可以观察到十二指肠。随着附属装置的不断改进，如手术器械、摄影系统的发展，内镜不但可用于诊断，且可用于手术，这意味着微创手术时代的到来。

　　Phase 2: Fiber Optic Endoscopy (since 1957) In 1954, based on the theoretical foundation that fiber conductive light sources and fiber to fiber cladding could solve fiber to fiber optical insulation, Hopkins and Kapany from the UK studied the precise arrangement of fibers, effectively solving the image transmission of fiber bundles and laying the foundation for the practical application of fiber optics. Endoscopy has achieved a historic breakthrough, with endoscopes utilizing fiber optic imaging taking the stage. In 1957, Curtiss and Hirschowitz combined a large amount of glass fibers into a bundle and fused these fibers together at the end to allow them to move independently according to their own length, thus creating the first soft endoscope. Hirschowitz and his research team have developed the world's first prototype of fiber optic endoscopy for examining the stomach and duodenum. In 1960, the American cystoscope manufacturer company (ACMI, now a legendary brand unknown to young people) provided Hirschowitz with the first commercial fiber endoscope. In 1964, Olympus factory added live devices and cameras on the basis of fiber optic gastroscopy, effectively displaying gastric photography and observing the condition of the stomach in real time. In 1966, Olympus factory pioneered the front-end bending mechanism. In 1967, Machida factory adopted an external cold light source, which greatly increased the brightness and allowed for the detection of small lesions, further expanding the field of view and allowing observation of the duodenum. With the continuous improvement of accessory devices such as surgical instruments and photography systems, endoscopes can not only be used for diagnosis, but also for surgical treatment, which means the arrival of the era of minimally invasive surgery.

　　Hirschowitz医生

　　Dr. Hirschowitz

　　第三阶段：CCD电子内镜（1983年起） 1983 年美国 Welch Allyn 公司研制并应用微型图像传感器(charge coupled device,CCD)代替了内镜的光导纤维导像术，宣告了电子内镜的诞生--内镜发展史上另一次历史性的突破。电子内窥镜主要由内镜(endoscopy)、电视信息系统中心(video information system center)和电视监视器(television monitor)三个主要部分组成，另外还配备一些辅助装置，如录像机、照相机、吸引器以及用来输入各种信息的键盘和诊断所用的各种处置器具等。它的成像主要依赖于镜身前端装备的 CCD，CCD 就像一台微型摄像机将图像经过图像处理器处理后，显示在电视监视器的屏幕上。比普通光导纤维内镜的图像清晰，色泽逼真，分辨率更高，而且可供多人同时观看。由于电子内镜的问世，给百余年来内镜的诊断和开创了历史新篇章，在临床、教学和科研中发挥出它巨大的优势。随后，日本的富士、奥林巴斯（1985年推出其电子内窥镜系统 EVIS-1）等企业相继宣告电子内镜的成功研制。从像素数量上看，光纤内镜的分辨率一般为2万像素，而应用CCD的电子镜分辨率一般是光纤内镜的20倍，这使得电子内镜的图像质量、细节信息、清晰程度都有了极大提升，基于内窥镜的诊疗技术开启了新的篇章。上世纪70~90年代，全球超过半数的半导体在日本生产，全球前10大半导体公司中，日本一度独占6家，这使得日本的内镜企业发展优势。

　　Phase Three: CCD Electronic Endoscopy (Since 1983) In 1983, Welch Allyn Company in the United States developed and applied a miniature image sensor (charge coupled device, CCD) to replace the optical fiber guidance of endoscopy, announcing the birth of electronic endoscopy - another historic breakthrough in the history of endoscopy development. Electronic endoscopes are mainly composed of three main parts: endoscopy, video information system center, and television monitor. In addition, they are equipped with auxiliary devices such as video recorders, cameras, suction devices, keyboards for inputting various information, and various treatment equipment used for diagnosis and treatment. Its imaging mainly relies on the CCD equipped at the front end of the mirror body. The CCD is like a miniature camera that processes the image through an image processor and displays it on the screen of a television monitor. Compared to ordinary fiber optic endoscopes, the image is clearer, the color is realistic, the resolution is higher, and it can be viewed by multiple people at the same time. Due to the emergence of electronic endoscopy, a new chapter in the history of endoscopic diagnosis and treatment has been opened for more than a hundred years, and it has played a huge advantage in clinical, teaching, and scientific research. Subsequently, Japanese companies such as Fuji and Olympus (which launched their first electronic endoscope system EVIS-1 in 1985) successively announced the successful development of electronic endoscopes. In terms of pixel count, the resolution of fiber optic endoscopes is generally 20000 pixels, while the resolution of electronic endoscopes using CCD is generally 20 times that of fiber optic endoscopes. This greatly improves the image quality, detail information, and clarity of electronic endoscopes, opening a new chapter in diagnosis and treatment technology based on endoscopes. In the 1970s and 1990s, more than half of the world's semiconductors were produced in Japan. Among the top 10 semiconductor companies in the world, Japan once monopolized 6, which gave Japanese endoscope companies a great development advantage.

　　CCD

　　CCD

　　第四阶段：CMOS电子内镜（1995年起）  1995年，几位华人留学生在硅谷创立豪威，这家企业实现了此后CMOS（Complementary Metal Oxide Semiconductor，互补金属氧化物半导体，一种集成电路的设计工艺）技术对图像传感器市场的破局。在当时的工艺条件下，CMOS的成像质量相较CCD稍差，但却可以做到功耗和成本的极大降低。随着索尼、三星等传统半导体巨头的加入和CMOS生产工艺的精进，CMOS图像传感器的性能逐渐提高，在内窥镜中的应用研究也逐渐展开。与CCD相比，CMOS传感器具有成本低、集成度高、耗电量小等优点。 2015年5月美国豪威被由中信资本、北京清芯华创和金石投资组成的财团以19亿美元收购，终于2016年初完成私有化，成为北京豪威的全资子公

　　Phase Four: CMOS Electronic Endoscope (Since 1995) In 1995, several Chinese international students founded Howay in Silicon Valley, which achieved the breakthrough of CMOS (Complementary Metal Oxide Semiconductor, a design process for integrated circuits) technology in the image sensor market. Under the process conditions at that time, the imaging quality of CMOS was slightly inferior to CCD, but it could achieve significant reductions in power consumption and cost. With the addition of traditional semiconductor giants such as Sony and Samsung and the improvement of CMOS production processes, the performance of CMOS image sensors is gradually improving, and research on the application of endoscopes is also gradually unfolding. Compared with CCD, CMOS sensors have the advantages of low cost, high integration, and low power consumption. In May 2015, American Howe was acquired by a consortium consisting of CITIC Capital, Beijing Qingxin Huachuang, and Jinshi Investment for $1.9 billion. It was eventually privatized in early 2016 and became a wholly-owned subsidiary of Beijing Howe

　　CMOS

　　CMOS

　　目前，市场上的软镜主要使用电子镜方案，CMOS摄像头在镜体前端，镜体可弯曲，镜体后端连接图像处理装置；硬镜中电子镜与光学镜两种方案并存，电子硬镜的优势是不像光学镜易损坏、不需手动调焦，而光学硬镜的优势是透镜组传像的保真度高，CMOS安装在镜体后端不受镜体直径限制。

　　At present, the soft mirrors on the market mainly use electronic mirror solutions, with CMOS cameras at the front end of the mirror body, which can be bent, and image processing devices connected to the back end of the mirror body; There are two solutions for hard mirrors: electronic mirrors and optical mirrors. The advantage of electronic hard mirrors is that they are not as easily damaged and do not require manual focusing as optical mirrors, while the advantage of optical hard mirrors is that the lens group has high fidelity in image transmission. CMOS is installed at the rear end of the mirror body and is not limited by the diameter of the mirror body.

　　总结

　　summary

　　CCD（电荷耦合器件）和CMOS（互补金属氧化物半导体）是两种不同类型的图像传感器，它们各有特点和优势，以下是CCD和CMOS的主要区别及各自的优点：CCD（Charge-Coupled Device）工作原理：CCD通过一个像素传递到另一个像素的方式来收集光，并将其转换成电子信号。图像质量：通常提供高质量的图像，具有的光学特性和较低的噪点。灵敏度：对光线的响应较好，适合低光照条件下拍摄。能耗：相对较高，因为所有像素都是通过一个输出节点来读取。CMOS（Complementary Metal-Oxide-Semiconductor）工作原理：CMOS传感器为每个像素配备了一个放大器，可以在像素处直接转换光信号为电信号。成本和制造：制造成本较低，因为它可以使用标准的半导体制造工艺。能耗：相比CCD，CMOS的能耗较低，更适合用于便携设备如智能手机。速度：数据读取速度更快，适合高速摄影和视频录制。CCD的优点：提供高质量的图像，特别是在色彩重现、动态范围和低光照条件下的性能方面。CMOS的优点：成本较低，能耗低，数据处理速度快，更适合快速拍摄和长时间使用。

　　CCD (Charge Coupled Device) and CMOS (Complementary Metal Oxide Semiconductor) are two different types of image sensors, each with its own characteristics and advantages. The main differences and advantages of CCD and CMOS are as follows: CCD (Charge Coupled Device) works by collecting light from one pixel to another and converting it into electronic signals. Image quality: Typically provides high-quality images with excellent optical properties and low noise. Sensitivity: Good response to light, suitable for shooting under low light conditions. Energy consumption: relatively high because all pixels are read through one output node. The working principle of CMOS (Complementary Metal Oxide Semiconductor): CMOS sensors are equipped with an amplifier for each pixel, which can directly convert optical signals into electrical signals at the pixel. Cost and Manufacturing: The manufacturing cost is lower because it can use standard semiconductor manufacturing processes. Energy consumption: Compared to CCD, CMOS has lower energy consumption and is more suitable for portable devices such as smartphones. Speed: Faster data reading speed, suitable for high-speed photography and video recording. Advantages of CCD: Provides high-quality images, especially in terms of color reproduction, dynamic range, and performance under low light conditions. Advantages of CMOS: Low cost, low energy consumption, fast data processing speed, more suitable for fast shooting and long-term use.

　　随着技术的发展，CMOS传感器的性能已经大幅提升，逐渐在许多应用领域取代了CCD传感器，特别是在消费级数码相机和手机摄像头中。然而，CCD仍然在一些和科学应用中保持着其优势地位。选择哪种类型的传感器取决于具体的应用需求、预算和期望的图像质量。

　　With the development of technology, the performance of CMOS sensors has been greatly improved, gradually replacing CCD sensors in many application fields, especially in consumer digital cameras and mobile phone cameras. However, CCD still maintains its advantageous position in some professional and scientific applications. The choice of which type of sensor depends on specific application requirements, budget, and expected image quality.

　　显然，一开始大家所熟知的电子内窥镜昂贵主要是由于CCD昂贵，CCD质量越好，呈现画面质量越高，也越高。后来CMOS出现了，成本比CCD还低，且于16年豪威完成私有化，大幅降低了国内企业的采购成本。这就解释了为什么一次性内窥镜采用的是电子芯片，而且也是近几年一次性内窥镜在国内蓬勃发展的主要原因。

　　Obviously, the well-known high cost of electronic endoscopes at the beginning was mainly due to the high cost of CCD. The better the quality of CCD, the higher the image quality presented, and the higher the price. Later on, CMOS emerged with lower costs than CCD, and in 2016, Huawei completed privatization, significantly reducing the procurement costs of domestic enterprises. This explains why disposable endoscopes use electronic chips, and it is also the main reason for the booming development of disposable endoscopes in China in recent years.

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